Spotlight on superbugs

Radio Scope Case Notes BBC Radio 4, TuesdayDuring the course of his lifetime, the average British man will take 50 courses of antibiotics, for a woman it's 70 courses.

Indeed, until relatively recently, most adults in the Western world would have found it inconceivable that, if they got an infection, there wouldn't be a five-day course of some antibiotic or other readily available to zap it.

The rise of super bugs (MRSAs) has put paid to that certainty and in the return of the excellent medical radio series Case Notes, BBCR4, presenter Dr Mark Porter raised the challenging question of whether we are now living in a post-antibiotic era and whether, as has frequently been claimed, most widely used antibiotics will be useless in 10 years.

According to Dr Mark Wilcox, director of infection control at Leeds teaching hospitals, MRSA is a serious problem and one that presents complex challenges for medical professionals, particularly in Britain where the hospital superbug rate is high.

Official figures in Britain for deaths due to antibiotic-resistant infections was 1,000 people last year, although medical professionals think the true figure could be closer to 5,000.

The majority of victims would have picked up the disease in hospital and the two current strains, "epidemic 15 and 16", are proving particularly successful in moving from person to person.

The presenter tried to tease out how contracting an MRSA might impact on an already sick person.

"What would happen if an MRSA bug landed on the wound of a hernia patient during an operation?" asked Dr Porter.

That patient could most likely be treated and sent home well, replied Dr Wilcox, before adding that the real problems arise when an MRSA gets into a bone or joint during, for example, a hip-replacement operation.

Such a fate befell one contributor, Mr Tony Fields, who contracted MRSA when he was in hospital for a hip replacement and he ended up, several very sick weeks later, without the new hip and part of his femur. He challenged the idea that MRSA comes simply from the historic overuse of antibiotics, suggesting that poor levels of hygiene play a significant part.

Once he survived the disease, he set up an MRSA support group and now advises soon-to-be hospital patients on how they can minimise the likelihood of contracting a superbug. He suggests washing thoroughly for several days before admittance with an antibacterial soap, not touching other patients and making sure that all medical professionals wash their hands.

"Two people did ask consultants to wash their hands and watch where their ties were hanging," he said, before admitting that, for most people, making such a request would be daunting in the extreme.

Mr Fields's theory sounded good if only because it seemed to empower patients, but Dr Wilcox was quick to reply that there is no evidence to support such a "dirty hospital" theory.

However, he did say that in hospitals where there is 100 per cent occupancy, where staff don't have the time to wash their hands up to 40 times a day and space restrictions mean not enough isolation rooms, superbugs get the opportunity to spread.

"MRSA has plateaued in the past two years," said Dr Wilcox, although he admitted to being unsure whether that means that the bug has found a level that it is happy with or whether measures to contain its spread are working.

However, the infection-control specialist said he couldn't see us running out of antibiotics in his lifetime. "If you take it that a large hospital has 1,000 beds and, of these, 10 will be in intensive care. One or two people will get a multi-resistant bug - it's a small proportion," Dr Wilcox said.